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The United States ranked last in health care performance of 11 high-income countries analyzed by the Commonwealth Fund. Of the five indicators examined-access to care, care process, administrative efficiency, equity, and health care outcomes-the United States ranked last in all but care process, for which it ranked second. The poor performance came at a higher cost as well; health care spending in the United States greatly exceeded that of the other countries, earning it a rank of 11th for affordability. And, despite the expenditures, measures of health care outcomes were particularly damning, including a preventable mortality rate in the United States more than double that of the best performing country in that category, Switzerland (177 deaths per 100,000 population versus 83 deaths per 100,000). The U.S. infant and maternal mortality rates were also the highest in the group. The overall top performers were Norway, the Netherlands, and Australia.